Brain and mind–PTSD and Lt. Whiteside

Philip Carter, writing in his exemplary blog, Intel-Dump, argues that the Army’s attempt to criminalize the behavior of Lt. Elizabeth Whiteside in the wake of her suicide attempt in Iraq represents a “hard case.” Carter sees a conflict between the Army’s need to discipline its troops and its imperative to take care of its own. (See this WaPo article for more details)

I’m fortunate to be innocent of any combat experience, but I was still struck by Carter’s insistance that Whiteside’s case presented the kind of dilemma he saw.

Think of the counterfactual. If a soldier, badly wounded on duty, attempted suicide while still under military discipline, I think most people would rightly see that action as a response to her circumstances: a symptom of the underlying medical condition of acute physical trauma, and not a criminal act. Why don’t we give the same consideration to Lt. Whiteside?

The answer lies, I think, with the fact that parts of the military appear to suffer from variants of Patton’s syndrome: the belief that if you can’t see where it hurts, then a claim of pain must be malingering.

But to get to the science in the case, Lt. Whiteside’s injury was not immaterial; it was simply much harder to spot than a battlefield wound.

Post Traumatic Stress Disorder (PTSD) — the condition from which Lt. Whiteside suffers — has been shown to be associated with at least some discoverable changes in the structure of the brain. For example, then-Yale, now Emory psychiatrist JD Brenner has done a number of functional MRI studies that show a several-percent diminution in the size of the hippocampus in studies of Vietnam era PTSD patients. (The link takes you to the first of Brenner’s reports on this.) Other work documents the involvement of other brain regions in response to PTSD. (Thanks to my student, B. Dolan, for finding that work for me).

In some sense, Brenner’s and others’ research offer penetrating glimpses of the obvious: stress is known to produce changes in the brain. The events suffered by soldiers in and around combat are obviously enormously potent sources of stress. And you should take at least one big caveat on this post: I have merely skimmed around the edges of current work on brains and trauma.

But even in such ignorance I’ll stand by the implications of one of the major themes of modern neurobiology. To oversimplify drastically: mind is a phenomenon of brain; mental trauma has a material context that cannot be ignored.

Given that, as I sit in my peaceful neighborhood of Boston, it looks to me that Lt. Whiteside suffered a serious, life-threatening injury to her brain in Iraq whose complications included the terrible wound in her stomach that she later inflicted on herself. I’d rather see the Army focus on care for that initial damage than on its sequel.

Update: Army examiner recommends no court martial for Lt. Whiteside. See this post for details.